Healthcare Provider Details

I. General information

NPI: 1114391315
Provider Name (Legal Business Name): KIMBERLY YVETTE HESTAND NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SYCAMORE ST
HOLLIS OK
73550
US

IV. Provider business mailing address

400 E SYCAMORE ST
HOLLIS OK
73550-1436
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2800
  • Fax: 580-688-2193
Mailing address:
  • Phone: 580-688-2800
  • Fax: 580-688-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number85865
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1015324
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: